Provider Demographics
NPI:1467139790
Name:TOMBLESON, ANTOINETTE
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:TOMBLESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KEYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:TIETON
Mailing Address - State:WA
Mailing Address - Zip Code:98947-9576
Mailing Address - Country:US
Mailing Address - Phone:916-878-6755
Mailing Address - Fax:
Practice Address - Street 1:120 N 50TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2800
Practice Address - Country:US
Practice Address - Phone:916-878-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health